Showing posts from category global health.
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Dispatches From the World Conservation Congress: Jason Bremner on Healthy Environments, Healthy People
›October 8, 2008 // By Jason Bremner
I’ve been busy the last several days attending the “Healthy Environments—Healthy People” stream of the World Conservation Congress. While there has been much talk about the connections between environmental services and people’s livelihoods and allusions to how this links with human health, I’ve been surprised by the scarcity of actual documented linkages between conservation strategies and human health.
This conundrum got me thinking about why there aren’t more people trying to actually evaluate impacts on human health. Do environmentalists simply lack the tools and expertise to evaluate human-health impacts? Are human-health benefits too hard to measure? Or does conservation not really have any human-health benefits? No, no, and no again are my answers to these questions.
I think the real problem is that “healthier people” is really just a good selling-point for conservation rather than a true objective of most conservation institutions. In other words, arguing that environmental health promotes human health is a good way for conservation organizations to expand their constituency.
Am I a jaded conference participant who has simply attended one too many sessions? I don’t think so, based on a meeting I attended last week of the EuroNGOs, a network of European organizations advocating for sexual and reproductive health. The topic of this year’s EuroNGOs meeting? The interface between population, environment, and poverty alleviation. Was this really a group of population and health organizations interested in adding an environmental dimension to their work or interested in the environmental benefits of their work? No—the real purpose was to increase funding for sexual and reproductive health by discussing the links and benefits related to environmental conservation and poverty alleviation. So these are different communities coming together for a common goal: to increase the funding for their particular missions.
Does this mean, however, that it is wrong to advocate for conservation interventions based on health benefits or wrong to advocate for health interventions based on environmental benefits? I don’t think so. I just think we need to do a better job of building bridges across communities. It would have been wonderful to have a few environmental organizations at the EuroNGOs meeting and a few more health organizations at the World Conservation Congress. Perhaps then we would do a better job evaluating the cross-sectoral benefits of our health and environment work.
Jason Bremner is program director for population, health, and environment at the Population Reference Bureau.
Photo courtesy of Geoff Dabelko. -
The More Things Change…Russia Embraces Free Trade (in Nuclear Waste)
›September 29, 2008 // By Geoffrey D. DabelkoI was disappointed but not surprised to receive a recent e-mail from Wilson Center Senior Scholar Murray Feshbach, warning me off visiting
The beginning of a September 26 St. Petersburg Times article gives us a glimpse of this selective Russian embrace of free trade:Up to 10,000 tons of depleted uranium hexafluoride are expected to travel through St. Petersburg in the next six months, according to the local branch of the international environmental pressure group Bellona….According to official sources, cargos containing depleted uranium hexafluoride arrive in the city on average ten times a month…radioactivity levels near the trains have significantly exceeded the norm on several occasions over the past year.
Environmental and health issues in Russia have not always looked so dire. In the early 1990s, in the wake of the fall of the Soviet Union, two exciting developments came out of northwest Russia from two unlikely sources: the military and civil society. In one of the most militarized regions of the world, the Russian military cooperated with the Norwegian military and eventually the
Health concerns connected to nuclear waste also formed the basis of a blossoming civil society movement in early-1990s
But even by the mid-1990s, the tide was beginning to turn back to a secretive and securitized approach to environmental data. The celebrated treason case of former Russian submarine captain Aleksandr Nikitin was merely the most visible example of the recriminalization of sharing environmental data. Nikitin’s “crime” was co-authoring the 1996 Bellona Foundation report The Russian Northern Fleet: Sources of Radioactive Contamination. Following a year of imprisonment and the achievement of Amnesty International prisoner status, Nikitin was released, but his celebrated case was succeeded by the Russian government’s broad-stroke efforts to dial back environmental openness and the rights that came with it. We may be seeing the effects of this return to environmental secrecy in the current row over nuclear waste transportation through St. Petersburg.
Photo courtesy of Woodrow Wilson Center. -
Senators McCain, Obama Announce Priorities for Alleviating Poverty, Tackling Climate Change at Clinton Global Initiative
›September 25, 2008 // By Rachel WeisshaarSpeaking at a Clinton Global Initiative plenary session (webcast; podcast) this morning, Senator John McCain (R-AZ) and Senator Barack Obama (D-IL) laid out their proposals for addressing the interconnected problems of global poverty, climate change, and disease. Excerpts from each senator’s speech are below.
Senator McCain:
“We can never guarantee our security through military means alone. True security requires a far broader approach using non-military means to reduce threats before they gather strength. This is especially true of our strategic interests in fighting disease and extreme poverty across the globe.”
“Malaria alone kills more than a million people a year, mostly in Africa….To its lasting credit, the federal government in recent years has led the way in this fight. But of course, America is more than its government. Some of the greatest advances have been the work of the Gates Foundation and other groups. And you have my pledge: Should I be elected, I will build on these and other initiatives to ensure that malaria kills no more. I will also make it a priority to improve maternal and child health. Millions around the world today—and especially pregnant women and children—suffer from easily prevented nutritional deficiencies….An international effort is needed to prevent disease and developmental disabilities among children by providing nutrients and food security. And if I am elected president, America will lead that effort, as we have done with the scourge of HIV and AIDS.”
“America helped to spark the Green Revolution in Asia, and…[we] should be at the forefront of an African Green Revolution. We should and must reform our aid programs to make sure they are serving the interests of people in need, and not just serving special interests in Washington. Aid’s not the whole answer, as we know. We need to promote economic growth and opportunities, especially for women, where they do not currently exist. Too often, trade restrictions, combined with costly agricultural subsidies for the special interests, choke off the opportunities for poor farmers and workers abroad to help themselves. That has to change.”
Senator Obama:
“Our security is shared as well. The carbon emissions in Boston or Beijing don’t just pollute the immediate atmosphere, they imperil our planet. Pockets of extreme poverty in Somalia can breed conflict that spills across borders. The child who goes to a radical madrassa outside of Karachi can end up endangering the security of my daughters in Chicago. And the deadly flu that begins in Indonesia can find its way to Indiana within days. Poverty, climate change, extremism, disease—these are issues that offend our common humanity. They also threaten our common security….We must see that none of these problems can be dealt with in isolation; nor can we deny one and effectively tackle another.”
“Our dependence on oil and gas funds terror and tyranny. It’s forced families to pay their wages at the pump, and it puts the future of our planet in peril. This is a security threat, an economic albatross, and a moral challenge of our time.”
“As we develop clean energy, we should share technology and innovations with the nations of the world. This effort to confront climate change will be part of our strategy to alleviate poverty because we know that it is the world’s poor who will feel—and may already be feeling—the effect of a warming planet. If we fail to act, famine could displace hundreds of millions, fueling competition and conflict over basic resources like food and water. We all have a stake in reducing poverty….It leads to pockets of instability that provide fertile breeding-grounds for threats like terror and the smuggling of deadly weapons that cannot be contained by the drawing of a border or the distance of an ocean. And these aren’t simply disconnected corners of an interconnected world. And that is why the second commitment that I’ll make is embracing the Millennium Development Goals, which aim to cut extreme poverty in half by 2015. This will take more resources from the United States, and as president, I will increase our foreign assistance to provide them.”
“Disease stands in the way of progress on so many fronts. It can condemn populations to poverty, prevent a child from getting an education, and yet far too many people still die of preventable illnesses….When I am president, we will set the goal of ending all deaths from malaria by 2015. It’s time to rid the world of a disease that doesn’t have to take lives.” -
Weekly Reading
›“African and global leaders must promote better integration of environment and health sectors and sustain more effective coordination across the continent,” argues an op-ed in The Lancet addressing the recent meeting of African health and environment ministers.Strengthening Land Tenure and Property Rights in Angola evaluates a U.S. Agency for International Development-funded project to bolster the land tenure and property rights of Angolans living in peri-urban and rural areas.
According to an article in the Christian Science Monitor, rebel groups in the
The Sierra Leone Integrated Diamond Management Program, which “was designed to improve local incentives for clean diamond management, enable local communities to benefit from the diamond resource, and to assist the Government of Sierra Leone (GOSL) in its effort to manage this critical resource,” has achieved considerable success over a short time period, according to a final report on the program.
The 2007 Liberia Demographic and Health Survey, available in full online, covers population; family planning; fertility; child health, mortality, and nutrition; maternal health, mortality, and nutrition; malaria, HIV/AIDS, and other diseases; gender-based violence; and a variety of other topics.
The
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Weekly Reading
›A report from the Center for Strategic and International Studies argues that the global food crisis poses a moral and humanitarian threat; a developmental threat; and a strategic threat. The authors recommend that the United States: modernize emergency assistance; make rural development and agriculture top U.S. foreign policy priorities; alter the U.S. approach to biofuels; ensure U.S. trade policy promotes developing-country agriculture; and strengthen relevant U.S. organizational capacities.
In an article in Scientific American, Jeffrey Sachs argues that the global food shortages Thomas Malthus predicted in 1798 may still come to pass if we do not slow population growth and begin using natural resources more sustainably.
A report by the Government Accountability Office finds that food insecurity in sub-Saharan African persists, despite U.S. and global efforts to halve it by 2015, due to “low agricultural productivity, limited rural development, government policy disincentives, and the impact of poor health on the agricultural workforce. Additional factors, including rising global commodity prices and climate change, will likely further exacerbate food insecurity in the region.”
In an article in the Belgian journal Les Cahiers du Réseau Multidisciplinaire en Etudes Stratégiques, Thomas Renard argues that climate change is likely to increase the risk of environmental terrorism (attacks that use the environment as a tool or target), eco-terrorism (attacks perpetrated on behalf of the environment), nuclear terrorism, and humanitarian terrorism (attacks targeting humanitarian workers).
A Community Guide to Environmental Health, available for free online in PDF, is a field-tested, hands-on guide to community-based environmental health. Topics include waterborne diseases; sustainable agriculture; mining and health; and using the legal system to fight for environmental rights. -
World Water Week Draws Attention to Taboo Topics Like Sanitation
›August 22, 2008 // By Geoffrey D. DabelkoA recent post on Andy Revkin’s Dot Earth blog—entitled “Poop is Funny, But It’s Fatal”—highlights a UNICEF World Water Day video about the necessity of destigmatizing human waste. Bacterial infections caused by contact with human waste kill 1.5 million people every year—most of them children. The stakes are high. The film uses kids and humor—two good ingredients for education through entertainment—to explain the importance of sanitation. The film emphasizes that although we may not like talking about feces, urine, toilets, and the like, we need to because the fact that 2.6 billion of us lack adequate sanitation is a fundamental threat to human health, productivity, and dignity. It’s a short film—YouTube friendly—and these are complex links, but they are key to understanding the need to invest in available technologies.
The UNICEF video rightly emphasizes the additional costs of lack of sanitation, noting that girls often won’t attend school if there isn’t adequate sanitation. The benefits of attending school longer include higher educational attainment, of course, but also the less-obvious knock-on effects: These young women are more likely to know and assert their rights in the household; they are more likely to earn more income; they often choose to have smaller families and better-spaced births, and are consequently able to concentrate their resources on the well-being of those children; their children are more likely to be better-educated—the list goes on.
The video leaves unspoken another sensitive topic: When adolescent girls begin to menstruate, they often either choose not to come to school or their parents (usually the father) pull them out of school if there aren’t “adequate” and separate facilities. This timing often correlates with young women’s assumption of greater responsibilities in the household, but it is also about the stigma associated with menstruation.
I’ve seen the connections between sanitation, education, and women’s equality have tremendous resonance with what is presumably a primary target audience of the UNICEF film—leaders in donor, government, and civil society communities who can mobilize resources. This example illustrates the urgency of overcoming the stovepiping that plagues so many development efforts, which often tackle education, economic growth, sanitation, and human health in isolation from one another, rather than in an integrated fashion. This year, the International Year of Sanitation, we should all make an effort to step out of our comfort zones and speak out about these “taboo” topics. -
Population Reference Bureau Releases 2008 World Population Data Sheet
›August 20, 2008 // By Sonia SchmanskiThe Population Reference Bureau (PRB) officially launched its 2008 World Population Data Sheet yesterday at the National Press Club. The 2008 Data Sheet features key population, health, environmental, and economic indicators for more than 200 countries. New in this year’s edition, co-authored by Carl Haub and Mary Mederios Kent, are data on percent of population in urban areas, number of vehicles per 100,000 people, and percent of population with access to improved drinking water.
Several findings highlight the significant health inequalities between wealthy and poor countries. For example, while around 1 in 6,000 women in developed countries dies from pregnancy-related causes, in the 50 least-developed countries, the risk is an astonishing 1 in 22. Because maternal mortality is generally seen as a proxy for the general state of a country’s health care system, these statistics point to alarming systemic health care failings in many of the world’s least-developed countries.
The 2008 World Population Data Sheet also highlights disparities between developed and developing countries in population growth rate trends; as wealthier countries’ populations stagnate or even begin to decline, the populations of the world’s poorest countries continue to grow at a rapid clip. PRB president Bill Butz noted that “[n]early all of the world population growth is now concentrated in the world’s poorer countries,” and that “[e]ven the small amount of overall growth in the wealthier nations will largely result from immigration.” As Kent pointed out at yesterday’s press conference, the United States is the major exception to this trend, because most of its population growth over the next several decades will come from natural increase.Unfortunately, the countries with the least access to improved water sources—and therefore some of the highest rates of diarrheal disease and child malnutrition—have among the world’s fastest-growing populations. For instance, in Ethiopia, which has a total fertility rate of 5.3 births per woman, only 42 percent of the population has access to an improved water source, and in Afghanistan, which has a total fertility rate of 6.8, the figure is a mere 22 percent.
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Access to Contraception Could Reduce Maternal Mortality by One Third, World Bank Reports
›August 14, 2008 // By Sonia SchmanskiFertility rates worldwide have been on the decline for many years, the result of a steady decrease in desired family size. But more often than not, fertility rates have not fallen as quickly as desired family size, as access to contraceptives has not kept pace with increasing demand. Consequently, more than 75 million pregnancies each year are unintended, finds “Fertility Regulation Behaviors and Their Costs: Contraception and Unintended Pregnancies in Africa and Eastern Europe & Central Asia,” a World Bank discussion paper surveying decades of research from Africa, Eastern Europe, and Central Asia. One fifth of these pregnancies end in induced abortion, fully half of which are classified as unsafe, meaning they are not attended by a properly trained health care worker or in an environment that conforms to minimum medical standards.
The costs of unsafe abortion are tremendous, financially and in terms of human lives. Approximately 67,000 women die annually from complications resulting from unsafe abortion, leaving more than 200,000 children motherless. Sexual and reproductive health issues constitute 20 percent of the global disease burden, and produce additional “direct and indirect costs to the individual woman, the woman’s household, the country’s health system and society as a whole.”
In Africa, post-abortion care can consume up to half of obstetrics and gynecology department budgets. The cost of this care is often much higher than the patient’s monthly salary. The authors report that “comprehensive family planning services to prevent unwanted pregnancy and reduce unsafe abortion in Nigeria would cost only a quarter of what is being spent in direct costs to treat post-abortion complications.” This point is taken up by author Margaret E. Greene is the latest issue of FOCUS, ECSP’s series of occasional papers featuring Wilson Center speakers. She writes that “[r]obust, compelling evidence linking good reproductive health to poverty reduction,” as is offered in the World Bank report, will “support efforts to include it in country-level poverty reduction strategies and in the allocation of international poverty reduction funding.”
This situation repeats itself across the globe. In Central Asia and Eastern Europe, induced abortion is “the principal method of birth control,” due to the expense of importing Western contraceptives, the medical community’s stigma against oral contraceptives, and the availability of abortion result. In Russia, government concerns about low fertility led the government to dismantle its sex-education curriculum and to carry out widespread layoffs in the government-controlled offices of contraceptive manufacturers.
Without exception, the case studies in this discussion paper find significant financial benefit to increasing modern contraceptive availability. Inadequate access is “an important barrier,” the authors write, discounting the argument that the contraceptives are there and people simply don’t use them. DHS surveys worldwide find that cost has prohibited contraceptive use for fewer than 2 percent of the estimated 137 million women with an unmet need. Women have decided, it seems, that the costs of childbearing far outweigh those of contraceptives.
“It is imperative,” the authors write, “that policies and programs address the need for contraception globally – for all population groups but with special emphasis on those who are most disadvantaged.” Community insurance schemes to reduce out-of-pocket payments can help accomplish this. Other ideas include increased subsidies for basic health services and adjusted user fee policies. The report also urges expanded and improved provision of contraceptive information and services, as well as improved training for health care providers. The problem is not a lack of good ideas and policies, but a lack of political will.
I’ve been busy the last several days attending the “Healthy Environments—Healthy People” stream of the 
I was disappointed but not surprised to receive a recent e-mail from Wilson Center Senior Scholar 
